The project will determine the incidence rates, patterns, timing and risks for progression of functional loss in community living older adults whose existing functional dependencies and co-morbidities put them at high risk for additional functional losses. Additional losses would decrease their quality of life, place additional burdens on their caregivers and substantially increase their risk for needing nursing home care. The first aim is to determine the incidence rates, patterns and timing of progressive loss of functioning. The second specific aim is to: 1) develop a prognostic index for functional decline using baseline risk factors, 2) examine how baseline risk factors interact with precipitating events (e.g. hospitalization) to increase the magnitude of functional loss experienced after these events, and 3) develop prognostic models for progressive functional decline that incorporates baseline values of and changes in psychological health, social functioning, sensory functioning and physical health. The Program for All Inclusive Care of the Elderly (PACE) provides care for community residing older adults who have functional dependencies and multiple co-morbidities. DataPACE contains quarterly health, functional and psychosocial assessments for more than 3,700 PACE enrollees from 12 PACE sites. Analyses of DataPACE will include: 1) the use of mixed models to determine site adjusted incidence rates of progressive functional loss, 2) functional principle components analysis to determine patterns of progressive functional decline over 2 years, 3) time to event analyses to describe the timing of additional losses in functioning, 4) logistic regression to develop a prognostic index, and 5) the use of repeated mixed models to describe how precipitating events and changes in psychological, social, functional, and health status contribute to progressive loss of ADL functioning over one and two years. Policy makers, clinicians and family members need to plan for the care of community living older adults with functional dependencies and multiple co-morbidities. Little research is focused on these older adults; this project will describe the scope of progressive functional loss in older adults who are on the cusp of needing nursing home care. Further, it will determine the health, functional, psychological and social risks of progressive functional loss in community living older adults with existing functional dependencies and multiple co-morbidities.